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The term “rectopexy” refers to an operation in which the rectum (the part of the bowel that is nearest the anus) is put back into its normal position in the body. Rectal prolapse is one of the more common reasons for performing a rectopexy. A rectal prolapse is an abnormal situation when the lower part of the bowel (rectum) becomes stretched and protrudes out through the anus (or back passage).
Laparoscopic Ventral Mesh Rectopexy (LVMR) is an operation which is designed to straighten and attach the rectum back into its normal position within the pelvis. The rectum is kept is this position using a mesh. The “mesh” may be made form either synthetic mesh made from a plastic similar to nylon or made me made from a “biologic” material that has an animal origin but is chemically treated so the body does not reject it.
A laparoscopic ventral mesh rectopexy differs from older rectopexy techniques in that the surgeon frees the rectum from the pelvis but operates only in front of the rectum and away from the nerves supplying the bowel and genitalia. Older rectopexy operations may result in damage to the nerves that supply the rectum and can be associated with constipation. The mesh is stitched to the front of the rectum and this mesh is in turn secured to the sacrum (lower backbone). The effect of this is to pull the bowel up out of the pelvis and prevent it from telescoping down, restoring it to its normal anatomical position.
Compared to older rectopexy operations, the lap. ventral rectopexy operation appears to give as good results in terms of fixing the prolapse. However, it gives seems to result is less constipation and patients usually have a much faster recovery.
One of the most common reasons for carrying out this procedure is for patients with external rectal prolapse (bowel coming out through the anus). A newer reason for surgery is internal prolapse or “intussusception” when the rectum slides in on itself, without coming out of the anus. This may cause obstructed defaecation syndrome (ODS) which causes a sensation of a blockage in the bowel, difficulty in passing a motion (having a poo) and prolonged (often unsuccessful) visits to the toilet. It can also mean you need to apply pressure with a finger or hand on the perineum (skin between the vagina/testicles and the anus), in the vagina or the anus to empty your bowels. Internal rectal prolapse sometimes also causes faecal incontinence (when you are unable to hold a bowel movement in).
Your specialist colorectal surgeon will want to assess your symptoms and to perform an examination of the anus and lower rectum (rigid sigmoidoscopy). Most patients who have this operation will a;sp require an endoscopic (telescope) test on the bowel (e.g. a colonoscopy). It is also usually necessary to assess how well the anal sphincter muscle works using ultrasound tests and special X-
The operation is performed using laparoscopic (keyhole) surgery and it involves a small cut just below the umbilicus (belly button) and two other small cuts on the right side of the tummy. It is performed under general anaesthetic (whilst you are asleep) and usually takes about one and a half hours. This operation loosens the rectum which is then gently pulled up out of the pelvis. A mesh (either a sterile sheet of plastic netting or a biologic mesh) is put in place to hold the rectum (bowel) in its normal place in the abdomen. The mesh will also prevent it from prolapsing back down into the pelvis (intussusception).
After the surgery you will normally have a urinary catheter in place (a tube into your bladder) and a drip in your arm. You will be allowed to eat and drink as soon as you want to after the operation, and your drip will be removed once you are drinking enough. Your anaesthetist will talk about pain control with you before the operation but usually painkilling tablets and liquids will be enough. Many patients can get away home the day after the operation.
It is important to avoid constipation and straining in the first few weeks after surgery. You may be prescribed laxatives to take for six weeks (e.g. Movicol™). Most patients are fit to drive after a week and can return to work after 2-
For patients with an external prolapse, the operation has a very low rate of recurrence (the prolapse coming back). If the operation is performed because of an internal prolapse or intussusception, obstructed defecation syndrome or faecal incontinence, about 4 out of 5 patients report a good improvement in their symptoms. Unfortunately, about 1 in 5 patients do not seem benefit from surgery, but there are additional treatments available which can help with the symptoms.
Laparoscopic ventral mesh rectopexy is usually felt to be seen as “low risk surgery” because no bowel is removed. An additional benefit of ventral rectopexy is that the nerves that supply bowel, bladder and sexual function are avoided. As a result, constipation which can be a problem with conventional rectopexy, only very rarely gets worse after LVMR.
Many patients with pre-
There are small risks of other problems including bleeding, infection, a hernia or bulge at one of the wounds or a problem with the mesh entering or piercing the bowel or vagina. This can happen months or even years after surgery and might require further surgery to fix it. The risk of this happening seems to be less with “biologic” mesh. However, some studies also suggest that biologic mesh may not be quite as effective in the long term compared with the synthetic mesh.
You will have the opportunity to discuss all the risks and benefits of the operation with your surgeon before signing the consent form.
The operation is suitable for even elderly patients (Glasgow Colorectal Centre surgeons have performed this operation on a 93 year old patient with an external prolapse). Occasionally extensive adhesions within the abdomen after previous abdominal surgery may make it impossible to perform a lap. ventral mesh rectopexy. However, it is usually possible to perform the operation if the surgery after previous appendicectomy, hysterectomy, or gallbladder surgery.
A laparoscopic (keyhole) procedure leaves less scarring and is less painful than open surgery (a cut down the middle of the tummy). The main benefit over other laparoscopic prolapse operations is that it seems to cause less constipation, which can be a problem with conventional open or conventional laparoscopic rectal prolapse surgery. However, it is important that that your surgeon uses mesh as this gives a longer lasting result than not using it. It is important that your surgeon also avoids damaging the important pelvic nerves which can cause constipation. Prolapse rarely comes back after laparoscopic surgery (2%) as opposed to operations through the perineum (20%).
Yes. Glasgow Colorectal Centre surgeons Richard Molloy and Graham MacKay both perform this operation on a regular basis and are happy to see you to assess your problem and advise if you are suitable for a laparoscopic ventral mesh rectopexy. Your GP will be able to make a referral to see them for an assessment.
If you have any questions about rectal prolapse or laparoscopic ventral mesh rectopexy, your own GP is often the best first port of call. If appropriate, they will be able to arrange a referral to a colorectal specialist centre such as the Glasgow Colorectal Centre.